Individual provider Active NPI

Samantha Grundemann, PA-C

  • Physician Assistant
  • Marshall, MI
National Provider Identifier
1821490459
Registry record updated Nov 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601007091 Issued in MI
Practice address
212 Winston Dr
Marshall, MI 49068-8526
Phone
(269) 781-6897
NPI assigned
Sep 26, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601007091 MI Primary

Addresses

Primary practice location

212 Winston Dr
Marshall, MI 49068-8526

Mailing address

601 John Street
Box 42
Kalamazoo, MI 49007

Other names 1

  • Samantha Grace Baker Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.bronsonhg.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141028001499 MI Practitioner - Physician Assistant 6709007156 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Bronson Battle Creek HospitalGroup PAC ID 0547173478, 187 clinicians

Practice addresses (Care Compare)

212 Winston Dr
Marshall, MI 49068-8526

300 N Ave
Battle Creek, MI 49017-3307

300 N Ave Outpatient Ctr 2ND FL
Bronson Neuroscience Center
Battle Creek, MI 49017-3307
Phone (269) 245-5862

Hospital & facility affiliations

  • Bronson Battle Creek Hospital Hospital, Battle Creek, MI, CCN 230075
  • Oaklawn Hospital Hospital, Marshall, MI, CCN 230217
  • Bronson Methodist Hospital Hospital, Kalamazoo, MI, CCN 230017

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5601007091MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Bronson Battle Creek Hospital Physician Assistant CurrentSince Jan 27, 2020 Accepting new patients

Locations

300 North Ave
Fl 2
Battle Creek, MI 49017
Phone (269) 245-5862

601 John St
#39
Kalamazoo, MI 49007

601 John St
Kalamazoo, MI 49007
Phone (269) 341-7100

601 John St
#42
Kalamazoo, MI 49007
Phone (269) 341-7806

212 Winston Dr
Marshall, MI 49068
Phone (269) 245-5460

Interoperability endpoints

  • Direct secure messaging: sgrundemann515558@direct.hfhs.org
  • Direct secure messaging: direct@direct.bronsonhg.org

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1411689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731283200000",
    "number": "1821490459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 JOHN STREET",
            "address_2": "BOX 42",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "49007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 WINSTON DR",
            "city": "MARSHALL",
            "state": "MI",
            "postal_code": "490688526",
            "telephone_number": "269-781-6897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRUNDEMANN",
        "first_name": "SAMANTHA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-26",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601007091",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.bronsonhg.org",
            "affiliation": "Y",
            "endpointDescription": "Bronson Healthcare Group Direct address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Continuity of Care Document",
            "address_1": "601 John St",
            "city": "Kalamazoo",
            "state": "MI",
            "country_code": "US",
            "postal_code": "490075341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "BAKER",
            "middle_name": "GRACE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Marshall, MI

Sources for this page

Verify at the official NPI Registry.